Page 12 - Excelligence 2022 Benefit Guide

Flexible Spending Accounts
A Flexible Spending Account (FSA) helps you pay for health care, or dependent care costs using tax-free dollars. Your contribution is deducted from your paycheck on a pretax basis and is put into the FSA. When you incur expenses, you can access the funds in your account to pay for eligible expenses. This chart shows the eligible expenses for each FSA and how much you can contribute each year. Each of these options reduces your taxable income.
Account type
Eligible expenses
Annual contribution limits
Health Care FSA
Most medical, dental and vision care expenses that are not covered by your health plan (such as copays, coinsurance, deductibles, eyeglasses and prescriptions)
Maximum contribution is $2,850 per year.
You cannot enroll if you are enrolled in the HSA Plan.
Funds are deducted throughout the year, but all funds are available on January 1.
Limited Purpose FSA
Dental and vision expenses only that are
not covered by your health plan (such as copays, coinsurance, deductibles, eyeglasses and prescriptions)
Maximum contribution is $2,850 per year.
This is available to those enrolled in the HSA Plan.
Funds are deducted throughout the year, but all funds are available on January 1.
Dependent Care FSA
Dependent care expenses (such as day care, after school programs or elder care programs) for children under age 13 or elder care so you and your spouse can work or attend school full-time
Maximum contribution is $5,000 per year ($2,500 if married and filing separate tax returns).
Important information about FSAs
Your FSA elections are effective from January 1 through December 31. Claims for reimbursement must be submitted by March 31 of the following year. Our Health Care or Limited Purpose FSAs allow you to carry over $570 in unused funds to the following plan year.
Please plan your contributions carefully. Any unused money remaining in your account(s) will be forfeited.
This is known as the “use it or lose it” rule and it is governed by Internal Revenue Service regulations. Note that FSA elections do not automatically continue from year to year; you must actively enroll each year.
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